Edward Teeple

Biphasic Depression of Ventilatory Responses to CO2 Following Epidural Morphine

The authors examined the duration of effects of lumbar epidural morphine (0.1 mg/kg) on control of ventilation (CO2 response), pain relief, segmental analgesia (loss of pain in response to a painful stimulus) and loss of temperature discrimination, and plasma morphine concentrations in seven patient

Aphasia and hemiparesis following stellate ganglion block.

The proximity of the stellate ganglion to the arterial vessel supplying the brain creates two problems. First, the close anatomical relation of the ganglion and the arteries increases the risk of intraarterial injection. Second, cerebral toxicity occurs at much lower total doses of local anesthetic when intraarterial injections are made into arteries that directly supply the brain (1). Excitatory reactions to local anesthetic injections into the vertebral artery, as well as blindness, have been described (2), but there have been no reports of symptoms after direct carotid artery injection with local anesthetics and few reports of depressive reaction to local anesthetic toxicity. In the present case, a patient experienced a transient episode of unconsciousness, expressive aphasia, and right hemiparesis after the injection of 2 ml of 1% lidocaine into, we postulate, the carotid artery. The case was unusual because the total dose of anesthetic was far below that expected to produce a reaction and the initial signs were depressive without antecedant excitatory central nervous system symptoms or signs.

Intrathecal normal saline without preservative does not have a local anesthetic effect

Abstract The effects of intrathecally administered normal saline (preservative‐free) were studied in patients undergoing differential spinal block anesthesia for evaluation of chronic pain below the waist. The injection of 5 ml saline did not significantly change the sensitivity to pinprick measured in the lower back and both lower extremities. Temperature measurement in both the lower extremities and psycho‐galvanic skin reflex did not show evidence of sympathetic block; the psychogalvanic skin reflex was abandoned because of inconsistent results. These findings refute the earlier conclusion of Urban and McKain who found that normal saline acts as a weak local anesthetic when injected intrathecally. We recommend use of normal saline (preservative‐free) in 5 ml doses as a placebo for differential spinal block anesthesia.